🧪 Randomized Clinical Trial • China
H. pylori eradication: tegoprazan–amoxicillin vs bismuth quadruple
A multicenter non-inferiority RCT comparing 14-day and 10-day tegoprazan–amoxicillin dual therapy with standard 14-day bismuth quadruple therapy.
90.3%
✅ Eradication (PP) — 14-day dual therapy
91.8%
🏁 Eradication (PP) — bismuth quadruple
67.2%
⚠️ Eradication (PP) — 10-day dual therapy
📈 Primary outcome
Eradication rates by analysis population
PP = Per-protocol; MITT = Modified intention-to-treat; ITT = Intention-to-treat
🧾 Clinical interpretation
What this means for patients
- ✅ 14-day dual therapy achieved eradication rates comparable to standard bismuth quadruple therapy.
- ❌ 10-day dual therapy showed clearly inferior efficacy and should not be used.
- 🙂 Adverse events were mild and similar across regimens.
- 🧩 Simpler regimens may reduce complexity without compromising outcomes.
🧭 Clinical decision
Why clinicians may prefer 14-day dual therapy
✅ Efficacy
Comparable to bismuth quadruple
PP: 90.3% vs 91.8% • MITT: 84.8% vs 90.5% • ITT: 73.7% vs 75.0%
🧩 Regimen simplicity
2 drugs vs 4 drugs
Tegoprazan + amoxicillin vs esomeprazole + bismuth + amoxicillin + tetracycline
🙂 Tolerability & adherence
Similar safety and compliance
Any AE: 15.2% vs 20.6% • Compliance ≥80%: 93.9% vs 96.8%
⚠️ Any adverse events
(lower is better)
✅ Compliance ≥80%
(higher is better)
❌ Avoid
10-day dual therapy underperforms
PP: 67.2% • MITT: 64.1% • ITT: 53.9%
✅ Consider 14-day dual therapy when
- you want a simpler regimen (two medications)
- comparable eradication outcomes are acceptable
- you want to reduce multi-drug complexity
🏁 Consider bismuth quadruple therapy when
- a standard “maximal” first-line regimen is preferred
- you prioritize maintaining high eradication rates across settings
- bismuth regimen logistics are not a barrier
⚠️ Do not shorten to 10 days
In this trial, shortening dual therapy to 10 days substantially reduced eradication rates.
Note: This block summarizes trial findings and does not replace local guideline requirements or antibiotic-resistance considerations.
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